Aortic Dissection in the Second Trimester of Pregnancy: Is It Possible to Save Both Lives?
DOI:
https://doi.org/10.1532/HSF98.20111023Abstract
Aortic dissection during pregnancy is a potentially catastrophic clinical condition and can be lethal to both mother and fetus. The treatment of aortic dissection in pregnancy is based on location, severity, and gestational age. We report a case of acute aortic dissection in a 30-year-old female patient in her 26th week of gestation. Ascending aorta resection and interposition of a 26-mm Dacron graft was carried out without circulatory arrest by means of a double-felt "sandwich" technique on both anastomoses. The patient was discharged from the hospital 10 days after her initial admission. At the 34th week of gestation, the patient delivered a healthy baby by cesarean section. Because our patient was hemodynamically unstable, our aim at the 26th week of gestation was to perform a simplified surgical procedure, to avoid circulatory arrest, and to maintain a high perfusion pressure, in order to save the patient's life and to decrease the potential risk of damage to the fetus.References
Avila WS, Dias R, Yamada RT, Armelin A. 2006. Acute aortic dissection during pregnancy. Arq Bras Cardiol 87:e112-5.nImmer FF, Bansi AG, Immer-Bansi AS 2003. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg 75:309-14.nJanuzzi JL, Isselbacher EM, Fattori R 2004. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 43:665-9.nMatsuda H, Ogino H, Neki R, Kitamura S. 2006. Hemiarch replacement during pregnancy (19 weeks) utilizing normothermic selective cerebral perfusion. Eur J Cardiothorac Surg 29:1061-3.nNienaber CA, Fattori R, Mehta RH 2004. Gender-related differences in acute aortic dissection. Circulation 109:3014-21.nPomini F, Mercogliano D, Cavalletti C, Caruso A, Pomini P. 1996. Cardiopulmonary bypass in pregnancy. Ann Thorac Surg 61:259-68.nSakaguchi M, Kitahara H, Seto T 2005. Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome. Eur J Cardiothorac Surg 28:280-3; discussion 283-5.nWakiyama H, Nasu M, Fujiwara H, Kitamura A, Okada Y. 2007. Two surgical cases of acute aortic dissection in pregnancy with Marfan syndrome. Asian Cardiovasc Thorac Ann 15:e63-5.n
